Using Medicaid to Cover Services for Elderly Persons in Residential Care Settings: State Policy Maker and Stakeholder Views in Six States. Requirements for Medicaid Assistive Care Services Reimbursement


  • An assisted living facility must be enrolled as a provider in order to bill for Medicaid personal care services through the Assistive Care Services (ACS) program.

  • Services covered under ACS are expected to take an average of about one hour per day and are reimbursed at a single per diem rate of $9.28. There is a recommendation to increase the daily rate by $2.00.

  • ACS providers who serve Medicaid clients receive a total of $854.80 for 30 days to cover room and board and services.

  • No payment is made for ACS services if the resident is absent for as few as 24 hours. However, the ACS program builds an allowance into the rate that assumes the resident will be absent about 10 days a year.18 There is no similar allowance built into the waiver rate.

18. One respondent stated that providers do not seem to understand that the rate is a little higher based on the assumption that residents will be away from time to time.

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